A45-09 Prophylactic Use of Tranexamic Acid (TXA) to Prevent Bleeding During Diagnostic Bronchoscopy: A Single Center Retrospective Study

Abstract Rationale Airway bleeding is a major complication of endobronchial biopsies. TXA is commonly used to control iatrogenic bleeding during bronchoscopy, however, the effectiveness of prophylactic intravenous tranexamic acid (TXA) to prevent intrabronchial bleeding is unknown. We assessed the efficacy (prevention and attenuation of bleeding) and safety (7-day complications) of IV TXA administered immediately before bronchoscopy. Methods We performed a retrospective, single-center cohort study of 200 bronchoscopies, grouped by receipt of prophylactic IV TXA versus no TXA (control). Intra-procedural bleeding was graded 1-4 (1 = minimal, 4 = severe). The primary endpoint was moderate-to-severe bleeding (grade ≥2). Secondary endpoints were severe bleeding (grade ≥3; typically requiring bronchial blocker or early termination of procedure), major bleeding (grade =4; requiring intubation or blood transfusion), and any 7-day post-procedural complication (ED or hospital admission, atelectasis, thromboembolic event, fever/antibiotics). Pre-specified subgroups included biopsy type (endobronchial biopsy EBB, transbronchial forceps biopsy TBB, cryo-TBB), location, presumptive diagnosis (Malignancy or Interstitial disease), pulmonary hypertension, and age. Groups were compared using Fisher’s exact tests. The study was approved by the institutional ethics committee. Results We analyzed 71 TXA and 129 control procedures. The primary outcome occurred in 28.2% of TXA cases (20/71) vs 22.5% of controls (29/129; p = 0.39). moderate bleeding (≥3) occurred in 11.3% vs 8.5% (p = 0.62), and severe bleeding (=4) was less frequent (4.2% vs 3.9%). Early post-procedural complication occurred in 14.1% vs 8.5% (p = 0.24). Subgroup patterns were descriptive: with cryo-TBB, moderate-severe bleeding was 28.6% (10/35) vs 25.7% (18/70); with TBB, 20.0% (5/25) vs 5.0% (2/40); with EBB, 33.3% (4/12) vs 33.3% (4/12). ILD cases and cryo-biopsies had higher bleeding overall. Tumor biopsies had lower bleeding rates (TXA 13.2% 5/38 vs. control 21.4% 18/84). In patients ≥70 years, bleeding was more frequent with TXA (38.5% 10/26 vs 19.1% 9/47); rates were similar in younger strata. None of the patients died, required embolization or surgery, or received blood transfusions. Conclusions In this real-world cohort, prophylactic IV TXA did not reduce the incidence or severity of intrabronchial bleeding, nor did it affect short-term safety after bronchoscopy. Given these results, we cannot recommend prophylactic IV TXA in diagnostic bronchoscopies. Further procedure-specific randomized trials are needed to mitigate bleeding risk, particularly in patients or procedures with high risk of bleeding. This abstract is funded by: N/A